The Practice Management Committee of the American Association of Hip and Knee Surgeons (AAHKS) is conducting a survey to assess differences in billing patterns for adult reconstruction surgeons. With the recent change in office E/M coding guidelines, it has led to widely varying approaches on how to bill standard office visits. We therefore would like to gather a baseline of current billing to allow for education and improvement for surgeons who may not have adapted to the new E/M guidelines. Please kindly respond as to how you would bill these types of visits.

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* 1. Scenario 1.
New patient visit: 66-year-old male BMI 34 with medication-controlled type II diabetes with end stage right knee arthritis. You have elected for weight loss, an intraarticular corticosteroid injection and a script for physical therapy.

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* 2. Scenario 2.
Follow patient visit: 66 year old male BMI 34 with medication controlled type II diabetes with end stage right knee arthritis. The patient has exhausted injections/PT/medication and you have indicated for outpatient total knee arthroplasty this visit

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* 3. Scenario 3.
2 week visit prior to surgical date: 66 year old male BMI 34 with medication controlled type II diabetes with end stage right knee arthritis. Consent signed and risks reviewed. Preoperative education provided Labs and medical clearance reviewed. Call to primary care provider planned to discuss their clearance and noted climbing A1C score of 6.9 from prior 6.5. Patient modified to overnight stay due to patient preference and desire for closer blood glucose monitoring.

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* 4. Scenario 4.
2 week post operative visit : 66-year-old male BMI 34 with medication-controlled type II diabetes with end stage right knee arthritis underwent right TKA 2 weeks prior. Progressing well with no concerns. Chief compliant is left (contralateral knee) pain- X rays of left knee taken in office noted to have severe osteoarthritis. Provided a cortisone shot to left knee and modified PT to cover both knees

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* 5. Scenario 5.
Annual follow up visit: 66-year-old male BMI 34 with medication controlled type II diabetes 1 year status post right TKA doing well. Stable left knee osteoarthritis asymptomatic. X rays ordered and reviewed with no changes. Encouraged home exercise, maintenance of body weight- follow up as needed

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